Bilateral primary B-cell lymphoma of testis in a three-year-old male child

Malti Kumari; Nuzhat Husain; Suresh Babu; SN Kureel

doi:10.4103/0377-4929.59228

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LETTER TO EDITOR

Year : 2010 | Volume : 53 | Issue : 1 | Page : 181-182

Bilateral primary B-cell lymphoma of testis in a three-year-old male child

Malti Kumari¹, Nuzhat Husain¹, Suresh Babu¹, SN Kureel²
¹ Department of Pathology, CSM Medical University, Lucknow, India
² Department of Paediatric Surgery, CSM Medical University, Lucknow, India

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Date of Web Publication

19-Jan-2010

How to cite this article:
Kumari M, Husain N, Babu S, Kureel S N. Bilateral primary B-cell lymphoma of testis in a three-year-old male child. Indian J Pathol Microbiol 2010;53:181-2

How to cite this URL:
Kumari M, Husain N, Babu S, Kureel S N. Bilateral primary B-cell lymphoma of testis in a three-year-old male child. Indian J Pathol Microbiol [serial online] 2010 [cited 2023 May 30];53:181-2. Available from: https://www.ijpmonline.org/text.asp?2010/53/1/181/59228

Sir,

Testicular lymphomas are rare and constitute one to nine per cent of all testicular neoplasia histologically most are diffuse large B-cell type and seen in males over age of 60 years.^[1],[2] Primary testicular lymphoma in children is extremely rare. Most reports of primary testicular lymphoma in children are limited to single case studies in literature and till date we have found 12 cases in literature reviewed. ^{[1],[2],[3],[4],[5]} We report a case of a three-year-old boy with bilateral progressively increasing testicular swelling with no lymphadenopathy or hepato-spleenomegaly [Figure 1]A. Biochemical assays for alpha fetoprotein, beta human chorionic gonadotrophin, liver and renal function tests were within normal limits. Ultrasonographic (USG) findings showed a heterogeneous lesion involving bilateral scrotum with a collection (40 ml) and dense internal echoes and few hypo echoic areas [Figure 1]B. Radiological findings were suggestive of an infected congenital hydrocele or tumor. Per-operative findings showed a bilateral solid testicular lesion along with minimal collection in the sac. The testes were delivered through inguinal approach and bilateral incision biopsies were done to establish the diagnosis. Histological evaluation showed testicular parenchyma infiltrated by diffuse population of small, round, indented cells, large cells with vesicular coarse chromatin, prominent nucleoli and scant amount of cytoplasm. Semeniferous tubules entrapped between tumor cells were immature and lacking spermatogenesis [Figure 2]A and B. Vascular invasion was not seen. Immunohistochemical (IHC) staining using antibodies against CD-45 RB (leukocyte common antigen) CD-20, CD-3, CD-56 and MPO and universal polymer based kit (Diagnostic Biosystems, Pleasanton, CA, USA) was done. The tumor showed diffuse expression for LCA with CD-20 expression in foci highlighting follicles indicating B cell lineage. CD-3 and MPO were negative. Immunohistochemistry also highlighted the follicles at places which seemed to be merging into diffuse population of tumor cells [Figure 2]C. Chest X-ray, computerized tomography (CT) abdomen and pelvis showed no evidence of lymphadenopathy. Bone marrow, blood smears and cerebrospinal fluid examined for lymphomatous infiltration were negative. Combined chemotherapy was started and patient responded well to the treatment.

Most cases of primary testicular lymphoma reported in children presented as unilateral testicular lesions. One case had bilateral involvement as seen in our case. Our case also showed accompanying hydrocele observed in three other cases reviewed. Age of cases ranged from three to 11 years; tumor size varied from 2.0-4.0 cm. ^{[1],[2],[3],[4],[5]} Most cases showed follicular large B-cell morphology, three of them had significant diffuse component.^{[1],[2],[3],[4]} One case of primary testicular lymphoma of T- cell type was also reported in a three-year-old male child.^[5] Treatment modalities differ and radical orchiectomy with combined chemotherapy appears to be treatment of choice.^{[1],[2],[3],[4]} Following incision biopsies, combined chemotherapy was started and the patient responded well to treatment. Precaution taken during bilateral incision biopsy saved the testes.

Primary testicular lymphoma in pre-pubertal boys is rare and may present with accompanying hydrocele. It is frequently B-cell follicular type and when localized to the testis appears to be associated with favorable prognosis.

References

1.	Finn LS, Viswanatha DS, Belasco JB, Snydr H, Huebner D, Sorbara L, et al. Primary follicular lymphoma of the testis in childhood. Cancer 1999;85:1626-35.
2.	Lu D, Medeiros LJ, Eskenazi AE, Abruzzo LV. Primary Follicular Large Cell Lymphoma of the Testis in a Child. Arch Pathol Lab Med 2001;25:551-4.
3.	Pileri SA, Sabattini E, Rosito P, Zinzani PL, Ascani S, Orcioni GF, et al. Primary follicular lymphoma of the testis in childhood: an entity with peculiar clinical and molecular characteristics. J Clin Pathol 2002;55:684-8.
4.	Pakzad K, Maclennan G, Elder J, Flom L, Trujillo Y, Sutherland S, Meyerson H. Follicular Large Cell Lymphoma Localized to the Testis in Children. J Urol 2002;168:225-8.
5.	Rodríguez JN, Moreno MV, Martino ML, Fernández-Jurado A, Uceda ME, Prados D. Primary testicular lymphoma. Report of two cases. Rev Clin Esp 1995;195:769-72.